Search Results (41)

Background: Obstructive sleep apnea syndrome (OSAS) and impaired nasal breathing are common in children and are frequently linked to maxillary constriction. Rapid maxillary expansion (RME) is an orthopedic treatment used to increase upper airway dimensions and improve respiratory function. It has been hypothesized that RME could contribute to improvements in behavior and cognition, possibly through enhanced sleep and respiratory function. It also promotes the shift from oral to nasal breathing, supporting craniofacial development and neuromuscular stability, and it is increasingly recognized as a multidisciplinary intervention that can improve pediatric health outcomes. With increasing evidence supporting its efficacy, RME should be considered not only for its orthodontic benefits but also as a multidisciplinary treatment option within pediatric care protocols. This underscores the importance of integrated care among orthodontists, ENT specialists, and pediatricians. Aim: To systematically assess the impact of RME on nasal respiratory parameters and sleep-disordered breathing, particularly OSAS, in pediatric patients. Methods: Following PRISMA guidelines, a systematic review was conducted using 12 clinical studies evaluating anatomical and functional respiratory changes after RME in children with mouth breathing or OSAS. Parameters included airway volume (CBCT, cephalometry), nasal resistance (rhinomanometry), and polysomnography (PSG) data. Results: RME consistently resulted in significant increases in nasal cavity volume and upper airway dimensions. Multiple studies reported reductions in the apnea–hypopnea index (AHI), improved oxygen saturation, and better subjective sleep quality. Longitudinal studies confirmed the stability of these benefits. However, variability in study protocols limited meta-analytical comparison. Conclusions: RME is effective in enhancing nasal breathing and mitigating OSAS symptoms in children. While results are promising, further high-quality randomized controlled trials are needed to validate these findings and guide standardized treatment protocols. Full article

Background/Objectives: This retrospective observational study evaluated associations among dentition type, age, systemic conditions, and oral pathology in pediatric patients. Methods: A six-month retrospective analysis was conducted in a specialized pediatric hospital. Patients (n = 155; 0–18 years) were grouped as clinically healthy with oro-maxillofacial diseases or with systemic diseases. Data included dental/periodontal status, anomalies, gingival bleeding index, IOTN score and oral mucosal conditions. Statistical tests (chi-square, ANOVA, and correlations) were applied. Results: Chronic gingivitis was most frequently associated with primary dentition. Caries and root debris were more frequent in ages 4–6, while acute gingivitis appeared in younger children. Orthodontic treatment need increased with age, especially in mixed dentition. Periodontal diseases were most often linked to digestive pathologies. Conclusions: Oral health in children showed associations with age, dentition type, and systemic conditions. Findings highlight associations rather than causation, underscoring the importance of prevention, early monitoring, and age-appropriate interdisciplinary management. Full article

Background/Objectives: Oral health plays a crucial role in the physical, emotional, and social well-being of children. Data from 2019 indicate that oral diseases remain a major concern in the Italian paediatric population, affecting not only children’s health but also caregivers’ well-being. This study aimed to assess the importance attributed by Italian families to their children’s oral health and correlate parents’ perceptions with children’s actual oral health status. Methods: A total of 131 children aged 0–12 years, admitted to the IRCCS Giannina Gaslini Children’s Hospital (Genoa, Italy) for reasons other than dental problems, were enroled between 1 January and 31 December 2024. Parents completed validated questionnaires (ECOHIS or PCPQ + FIS) based on their child’s age, along with supplementary questions on socio-demographic background and dental history. Oral examination was performed to assess dmft/DMFT scores, the Index of Orthodontic Treatment Need (IOTN), and the Modified Gingival Index (MGI). Results: In younger children (0–5 years), oral health was generally good, but the presence of caries negatively impacted the family’s quality of life. Older children (6–12 years) showed higher rates of caries and gingival inflammation, affecting their daily functioning and emotional well-being. Poor oral health was more common among children of non-European backgrounds and those with lower parental education. Early dental visits, within the recommended 24 months of age, were rare. Conclusions: Despite clear international recommendations, early dental visits remain uncommon, and many children experience preventable oral health issues. These findings highlight the urgent need to improve caregiver education and public health strategies to promote early preventive dental care. Full article

Background: Obstructive sleep apnea (OSA) is a prevalent disorder in both pediatric and adult populations, characterized by substantial morbidity encompassing cardiovascular, neurocognitive, and metabolic impairments. Management strategies vary by age group and underlying etiology, with orthodontic and non-orthodontic interventions playing key roles. This narrative review synthesizes the current evidence on orthodontic and non-orthodontic therapies for OSA in pediatric and adult populations, emphasizing individualized, multidisciplinary care approaches and highlighting future research directions. Methods: A narrative review was conducted using PubMed, Scopus, and Google Scholar to identify studies on diagnosis and management of OSA in children and adults from 2000 to 2025. Results: In pediatric patients, treatments such as rapid maxillary expansion (RME), mandibular advancement devices (MADs), and adenotonsillectomy have shown promising outcomes in improving airway dimensions and reducing apnea–hypopnea index (AHI). For adults, comprehensive management includes positive airway pressure (PAP) therapy, oral appliances, maxillomandibular advancement (MMA) surgery, and emerging modalities such as hypoglossal nerve stimulation. Special attention is given to long-term treatment outcomes, adherence challenges, and multidisciplinary approaches. Conclusions: The findings highlight the need for individualized therapy based on anatomical, functional, and compliance-related factors. As the understanding of OSA pathophysiology evolves, orthodontic and adjunctive therapies continue to expand their role in achieving durable and patient-centered outcomes in sleep apnea management. Full article

Background: The Index of Orthodontic Treatment Need (IOTN) is widely used to assess the need for orthodontic treatment. IOTN consists of the Dental Health Component (DHC) and the Aesthetic Component (AC), evaluating malocclusion morphologically and aesthetically, respectively. However, the discriminatory power of individual DHC items and their relationship with AC grades remain unclear. Objective: This study aimed to evaluate the effectiveness of individual DHC items in school dental examinations and investigate their contribution to AC grades among junior high and high school students. Methods: A total of 726 students (443 males, 283 females; aged 12–18 years) from Tsurumi University Junior and Senior High School, excluding 168 students undergoing or having completed orthodontic treatment, were included. Nine calibrated orthodontists assessed DHC and AC using IOTN during standardized school examinations. The discriminatory power and information precision of DHC items were evaluated by Item Response Theory (IRT) analysis using three-, two-, or one-parameter logistic models depending on convergence. Correspondence analysis visualized the correlation between DHC and AC grades. Simple linear regression analyzed the contribution of each DHC item to AC grades. Results: Orthodontic treatment need was identified in 21.1% of students. Females showed a higher rate of treatment need than males. Correspondence analysis suggested that aesthetic evaluations were more lenient than morphological evaluations. IRT and regression analysis revealed that crowding (4.d), increased overjet (2.a), and increased overbite (2.f) demonstrated high discriminatory power and significant contributions to AC grades. Conclusions: Among the DHC items, crowding, increased overjet, and increased overbite had higher discriminatory power for malocclusion and contributed more significantly to AC evaluations compared to other items. Full article

Background: Childhood obesity and overweight conditions impact systemic health and craniofacial development. Objectives: This review assessed the influence of elevated body mass index (BMI) on craniofacial morphology, considering age, sex, and ethnicity. Methods: A comprehensive search of Scopus, Web of Science, Embase, Cochrane, PubMed, and OpenGrey was conducted following PRISMA guidelines. Ten cross-sectional studies involving 1383 individuals aged 6 to 18 years were included. The sample comprised 812 females and 571 males, with most studies focusing on adolescents aged 12–18 years of different ethnicities depending on the study. Craniofacial structures were compared between overweight/obese and normal weight groups through cephalometric analysis. Study quality was assessed using the Newcastle–Ottawa Scale (NOS). Results: Overweight and obese individuals showed significant craniofacial changes, including increased anterior cranial base length, maxillary and mandibular dimensions, bimaxillary prognathism, and greater soft tissue thickness. These alterations may be influenced by differences in tissue composition, hormonal fluctuations, fat-to-bone ratio, and metabolic disorders. Variations in skeletal divergence, dental alignment, and airway space were also observed. The methodological quality ranged from moderate to high. Conclusions: Excess weight during growth is linked to distinct craniofacial alterations. Orthodontic diagnostics should integrate metabolic and hormonal considerations to optimize treatment outcomes. These changes should be carefully considered by orthodontists and pediatric dentists. Longitudinal studies are needed to understand the long-term effects of obesity on craniofacial development. Full article

Patient demands for aesthetic orthodontic brackets (OBs) has increased since orthodontic treatments are of long duration. Clinicians encounter old composite restorations frequently, against which OBs need to be bonded. This study aims to determine the shear bond strength (SBS) of two aesthetic OBs (ceramic and resin) against aged composite resins (flowable and packable) after standard surface treatment. A total of 96 disk-shaped specimens of two aged (A) composite resins [flowable (F) and packable (P)] were divided into eight groups, using ceramic (C) and plastic (P) brackets, out of which four subgroups served as the control [non-aged (N)FC, NPC, NFR, NPR] and four as experimental [AFC, APC, AFR, APR]. Surface treatment included mechanical [air abrasion] and chemical [Assure Plus and Transbond XT]. After 24 h of storage, the specimens were tested for SBS and observed for failure mode using adhesive remnant index scores. Mean values of SBS in each subgroup were analyzed statistically using a one-way analysis of variance test and Tukey post hoc test. All probability ‘p’ differences were significant at a value of 0.05 and less. All aged composite resin subgroups had decreased bond strength than controls, with all subgroups bonded with plastic brackets having the least bond strengths that were clinically nonacceptable [≤7 to 10 MPa]. Flowable composites when bonded with either ceramic or plastic brackets had higher strength than packable composites. Ceramic brackets had higher SBS than plastic brackets for both flowable and packable composites. Significant differences in bond strength were observed among subgroups of plastic brackets. Ceramic brackets were associated with a higher residue of adhesives on the composite surface. Aged composite resins exhibit significantly lower SBS than fresh composites, with ceramic brackets and flowable composites producing better bond strength values than plastic brackets and packable composites. Full article

White spot lesions (WSLs) are demineralized lesions of the enamel that form in the presence of bacterial plaque, affecting the aesthetics by modifying the refractive index of the enamel, giving the characteristic “chalky” aspect. They have various causes, including fixed orthodontic treatments, improper hygiene, fluorosis and genetic factors. Background/Objectives: Considering the latest need for dental aesthetics and the popularization of fixed orthodontic treatments, the need to effectively treat WSLs has increased. The objective of this research is to review the development of WSLs and their treatment with resin infiltration. Methods: The PubMed, Web of Science, Scopus and Google Scholar databases were searched for relevant reviews and studies. Out of all, 56 were included in this research. Results: Prophylactic measures, such as fluorized toothpaste and varnishes, have limited results. Standard caries treatment is too invasive as it removes too much healthy enamel for obturation retentivity. The resin infiltration resin process does not require drilling or tooth structure loss, making it a painless and minimally invasive treatment. The resin used has a refractive index comparable to that of healthy enamel, consequently restoring aesthetics and ensuring the prevention of caries evolvement. The treatment involves five important steps: prophylaxis, acid demineralization, alcohol drying, resin infiltration and UV light curing. Depending on the clinical case, the demineralization and drying steps may need to be repeated. Conclusions: Infiltrations with resin are painless and well tolerated by patients. Out of all minimally invasive treatments, they have an immediate satisfactory outcome, with results stable for a minimum of 45 months. Full article

Pycnodysostosis (PDS) is an autosomal recessive form of osteosclerotic skeletal dysplasia characterized by craniofacial anomalies, a high-arched palate, and a narrowed pharyngeal space due to mandibular and maxillary deficiencies. These structural anomalies in the upper airway predispose PDS patients to obstructive sleep apnea (OSA). OSA can be managed in PDS patients using either a conservative (non-surgical and multidisciplinary) approach or surgical interventions. Given the craniofacial anomalies associated with PDS, orthodontic treatment aims to address the maxillary transverse deficit and retrognathia. Currently, there is no evidence regarding the impact of orthodontic therapy on OSA levels among PDS patients. This study reports the long-term morphological and functional changes in the upper airway of a PDS patient following adenotonsillectomy and uvulopalatoplasty at an early age (3.6 years) and orthodontic camouflage in late mixed dentition (10 years). Polysomnographies (PSGs), nuclear magnetic resonance (NMR), and lateral cephalograms taken before and after ENT surgery and orthodontic treatment were analyzed. Lateral X-rays were evaluated for changes in the posterior airway space (PAS), while polysomnographies provided the apnea–hypopnea index (AHI). The NMR scans were segmented to measure the perimeter and radius of the upper airway. The findings of this study indicate that improvements following uvulopalatoplasty (UPP) were partial and temporary. Nonetheless, orthodontic therapy and the use of elastics did not appear to influence the PAS or AHI. Future studies with larger cohorts are needed to evaluate the long-term effectiveness of the UPP procedure. This study was conducted in accordance with the CARE guidelines. Full article

The aesthetic component (AC) of the Index of Orthodontic Treatment Need (IOTN) is internationally recognized as a reliable and valid method for assessing aesthetic treatment need. The objective of this study is to use artificial intelligence (AI) to automate the AC assessment. A total of 1009 pre-treatment frontal intraoral photos with overjet values were collected. Each photo was graded by an experienced calibration clinician. The AI was trained using the intraoral images, overjet, and two other approaches. For Scheme 1, the training data were AC 1–10. For Scheme 2, the training data were either the two groups AC 1–5 and AC 6–10 or the three groups AC 1–4, AC 5–7, and AC 8–10. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were measured for all approaches. The performance was tested without overjet values as input. The intra-rater reliability for the grader, using kappa, was 0.84 (95% CI 0.76–0.93). Scheme 1 had 77% sensitivity, 88% specificity, 82% accuracy, 89% PPV, and 75% NPV in predicting the binary groups. All other schemes offered poor tradeoffs. Findings after omitting overjet and dataset supplementation results were mixed, depending upon perspective. We have developed deep learning-based algorithms that can predict treatment need based on IOTN-AC reference standards; this provides an adjunct to clinical assessment of dental aesthetics. Full article

(1) Objective: This study aimed to investigate how patients’ perceptions of their dental aesthetics and their sense of self-esteem are related. (2) Methods: This cross-sectional survey recruited 141 new patients seeking orthodontic treatment. Patients completed a self-administered questionnaire consisting of three parts: the Malaysian Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ), Rosenberg Self-esteem Scale (RSES-M), and Aesthetics Component of the Index of Orthodontics Treatment Need (IOTN-AC). Clinical assessment comprised the Dental Health Component of the Index of Orthodontics Treatment Need (IOTN-DHC). Multiple linear regression was performed, with self-esteem as the dependent variable, while the independent variables comprised the domains of PIDAQ; IOTN-AC; IOTN-DHC; and patients’ demographics, such as age, gender, and their level of education. (3) Results: The response rate was 96.5% (n = 136 respondents). The multiple linear regression found that, when the other predictors in the model are held constant, Social Impact, Aesthetic Concern, and Dental Self-Confidence are the factors that significantly contributed to explaining the variation in self-esteem, accounting for, 3.9%, 2.3%, and 2.0%, respectively. The entire model explained 23% of the variation in self-esteem. (4) Conclusions: Domains of the psychosocial impact of dental aesthetics act as predictors of self-esteem in orthodontic treatment-seeking patients. Full article

This scoping review aims to investigate the latest literature concerning the use of smartphone applications (apps) in the prevention, management, and monitoring of oral diseases. Smartphone applications are software programs that are designed to run on smartphones. Nowadays, smartphones are regularly used by people of all ages, and mobile health apps (MHAs) represent an important means of spreading information related to oral health, which is the state of the mouth and teeth, including the gums and other tissues. Several apps have been designed to promote prevention, diagnosis, and therapeutic adherence monitoring. This scoping review considered randomized clinical trials, cross-sectional studies, before–after (pre–post) studies with no control group, and observational studies. Once the inclusion and exclusion criteria had been defined, a preliminary confined search was performed on PubMed and Scopus; key terms from the collected articles were selected to design a search strategy, and then a search of all the included articles’ reference lists was run for further research. Studies were excluded if they did not fulfill the inclusion criteria. The preferred reporting items for scoping reviews (PRISMA-ScR) consensus was followed. The risk of bias was evaluated by providing a qualitative analysis of the clinical studies via the National Heart, Lung, and Blood Institute (NHLBI) Quality Assessment of Controlled Intervention Studies, Observational Cohort Studies, and Cross-Sectional Studies (NHLBI, NIH). A total of 21 studies were included in this review. As it is clear from the studies selected, the literature indicates that MHAs are effective in improving oral hygiene in adolescents and children and reducing the dental plaque index, including in patients undergoing orthodontic treatment. MHAs are also able to reduce the symptoms of patients affected by obstructive sleep apnea–hypopnea syndrome (OSAHS) and improve the swallowing-related quality of life of elderly patients. MHAs are furthermore recommended to decrease dental anxiety among patients, both during dental procedures and the post-operative period. MHAs are useful to spread knowledge about traumatic dental injuries among non-oral health professionals and to monitor dental erosion and awake bruxism. MHAs’ clinical outcomes might have been influenced by the demographic features of the subjects involved. Further studies considering a longer follow-up period and larger samples are needed. In conclusion, MHAs can be considered a useful tool to monitor oral disease and increase patients’ quality of life related to oral health. Full article

Novel strategies to combat dental biofilms aim at reducing biofilm stability with the ultimate goal of facilitating mechanical cleaning. To test the stability of dental biofilms, they need to be subjected to a defined mechanical stress. Here, we employed an oral care device (Airfloss) that emits microbursts of compressed air and water to apply a defined mechanical shear to 14-day-old dental plaque in 20 healthy participants with no signs of oral diseases (clinical trial no. NCT05082103). Exclusion criteria included pregnant or nursing women, users of oral prostheses, retainers or orthodontic appliances, and recent antimicrobial or anti-inflammatory therapy. Plaque accumulation, before and after treatment, was assessed using fluorescence images of disclosed dental plaque on the central incisor, first premolar, and first molar in the third quadrant (120 images). For each tooth, the pre- and post-treatment plaque percentage index (PPI) and Turesky modification of the Quigley-Hein plaque index (TM-QHPI) were recorded. The mean TM-QHPI significantly decreased after treatment (p = 0.03; one-sample sign test), but no significant difference between the mean pre- and post-treatment PPI was observed (p = 0.09; one-sample t-test). These data are of value for researchers that seek to apply a defined mechanical shear to remove and/or disrupt dental biofilms. Full article

This study investigated the need for orthodontic treatment in asthmatic children aged 11 to 14 years and how the treatment affected their oral health-related quality of life (OHRQoL). Materials and Methods: This cross-sectional study was conducted at the dental clinic of the University of Salamanca in 2020–2022. The study selected a consecutive sample of 140 children with asthma (52.1% girls; 47.9% boys). This study used the Orthodontic Treatment Needs Index (OTN) to analyze the need for orthodontic treatment and the Children’s Perception Questionnaire (CPQ11–14) to assess OHRQoL. Results: Sex and age did not significantly influence the need for orthodontic treatment, although age may be considered influential for OHRQoL concerning oral symptoms (p < 0.01), functional limitations (p < 0.05), and total score on the CPQ_11–14 questionnaire (p < 0.05): the younger the age, the greater the effect of the need for orthodontic treatment on OHRQoL. The social well-being of the patients was much more significantly impacted by the need for orthodontic treatment (15.7 ± 1.91) than by oral symptoms (7.64 ± 1.39), which were the least impacted. In all parts of the CPQ_11–14 questionnaire and in the patients’ total scores, we observed significant agreement (p < 0.01) that treatment influenced OHRQoL. Conclusion: An inverse relationship exists between the severity of the treatment needed and OHRQoL. Full article

This study assessed the prevalence of orthodontic treatment needs and oral health-related quality of life (OHRQoL) in 12–18-year-old adolescents and explored the association between OHRQoL and treatment needs, gender, education level and family income. A total of 243 participants with no prior history of orthodontic treatment were included in this cross-sectional study utilizing a standardized self-explanatory questionnaire and clinical examination. The questionnaire consisted of two parts. The first part included the participants’ demographics (age, gender, education level, economic status) and the second part contained the Arabic version of the oral health impact profile (OHIP)-14, which consists of 14 questions to assess the impact of the severity of malocclusion on routine activities. The clinical examination involved the dental health component (DHC) index of orthodontic treatment needs (IOTN). The outcome of the study showed that 46% of participants had little or no treatment needs, followed by 23.5% with borderline needs, and 30.5% with severe needs. Female participants had higher mean OHIP-14 scores (10.94 ± 8.17) compared to their male counterparts (8.44 ± 7.15), and the difference in the mean scores was significant (p = 0.015). The educational level did not significantly influence the mean OHIP-14 scores (p = 0.723), whereas the family income correlated negatively with the mean OHIP-14 scores. Participants with less family income had higher mean OHIP-14 scores (11.53 ± 8.67) compared to participants with high (8.22 ± 6.71) and average family income (10.68 ± 8.30). The mean OHIP-14 scores between the family income groups were statistically significant (p = 0.036). The overall OHIP-14 score of the participants was 9.67 ± 7.75. The need for orthodontic treatment is crucial among adolescents. It is recommended to have regular orthodontic consultations for adolescents and prompt referral for treatment to improve the OHRQoL. Full article